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Extraneous neuroscience information improves ratings of scientific explanations, and affects mock juror decisions in many studies, but others have yielded little to no effect. To establish the magnitude of this effect, we conducted a random-effects meta-analysis using 60 experiments from 28 publications. We found a mild but highly significant effect, with substantial heterogeneity. Planned subgroup analyses revealed that within-subjects studies, where people can compare the same material with and without neuroscience, and those using text, have stronger effects than between-subjects designs, and studies using brain image stimuli. We serendipitously found that effect sizes were stronger on outcomes of evaluating satisfaction or metacomprehension, compared with jury verdicts or assessments of convincingness. In conclusion, there is more than one type of neuroscience explanations effect. Irrelevant neuroscience does have a seductive allure, especially on self-appraised satisfaction and understanding, and when presented as text., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bipolar disorder is a chronic, relapsing illness characterised by recurrent episodes of manic or depressive symptoms, with intervening periods that are relatively (but not fully) symptom-free. Studies have found higher rates of psychiatric disorders in homicide offenders than in the general population. The insanity defence is a legal construct that, under some circumstances, excuses defendants with mental illness from legal responsibility for criminal behaviour. Here we report two cases of family murder by the mother of the family caused by bipolar disease. The role of the forensic psychiatrist in diagnosing insanity during the commission of a crime is very important as these patients should be diagnosed, treated as soon as possible, and monitored. Public education through social media should be considered to reduce crimes in societies. Diagnosing insanity during the commission of a crime is very important and requires high precision forensic psychiatry. Public education through social media should be considered to reduce crimes in societies.

Objective: Regina v Presser [1958] VR 45, is the most seminal case regarding fitness to plead for accused persons in Australia and New Zealand. It is not widely understood that Presser was a 14-year-old boy with intellectual disability. We aim to describe a clearer narrative regarding Edward John Presser., Method: Review of attainable newspaper reports framed within an historical context of fitness and relevant case law., Results: Presser's narrative is described in greater detail than previously understood by clinicians and lawyers. Ramifications for fitness assessment are discussed including doli incapax and human rights considerations., Conclusions: The Presser criteria are widely applied; however, the case involved a 14-year-old boy with intellectual disability. Greater awareness of Presser's narrative assists clinicians providing expert evidence regarding fitness to plead for adolescents and persons with intellectual disability., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

Sleep experts are called to assist the jury in deciding the mental state of the accused at the time of their alleged criminal behaviour. This task is difficult as the literature on many sleep disorders, particularly sleepwalking and other parasomnias, is still largely a matter of case reports and case series. The probative value of much of the evidence given is not known. Sleep behaviour in the courts present a number of difficulties which illustrate the dilemmas that face an expert witness faced with ambiguous data and uncertain principles with which to interpret them. Additionally there are substantial policy issues involved which are not always adequately addressed in expert evidence. We outline the role of expert witnesses in such cases., (© The Author(s) 2015.)

The article offers an overview of the Law Commission's project on Insanity and Automatism and the provisional conclusions reached in its Discussion Paper in 2013., (© The Author(s) 2015.)

This paper examines some of the issues raised by the current criminal law defence of automatism and the related defence of insane automatism, and considers what neuroscience may contribute to the reform discussion. It also considers some of the claims made in relation to the impact of neuroimaging in the courtroom. It examines an American medical case report in which an individual's criminal behaviour is linked to a brain tumour, and considers how the reformed law as presented in the Law Commission for England and Wales' Discussion Paper might treat such claims. It concludes by examining what assistance the law may gain from a deeper understanding of how a sense of agency emerges from brain states, and the implications of this scientific knowledge for the reform of the law., (© The Author(s) 2015.)

The automatism defence has been described as a quagmire of law and as presenting an intractable problem. Why is this so? This paper will analyse and explore the current legal position on automatism. In so doing, it will identify the problems which the case law has created, including the distinction between sane and insane automatism and the status of the 'external factor doctrine', and comment briefly on recent reform proposals., (© The Author(s) 2015.)

Background: Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences., Objective: To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team., Design: The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention., Results: Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery., Conclusions: Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.

Objective: The purpose of this study was to examine which psychiatric symptoms were associated with a defence of unsoundness of mind for serious violent offences., Method: The study included psychiatric reports provided by forensic psychiatrists from the High Secure Inpatient Service for patients found to have a mental health defence by the Mental Health Court between June 2004 and June 2009., Results: The defence of unsoundness of mind was invariably associated with psychotic symptoms. All reports concluded that the patient was deprived of knowledge of the wrongfulness of the act. Patients found to be additionally deprived of the capacity to understand their actions suffered delusional beliefs about the identity of the victim. The symptoms that resulted in a small number of patients being considered deprived of the capacity to control their actions were mixed, but approximately a third suffered passivity phenomena., Conclusions: Psychiatrists should be specific about how the patient's symptoms link to any deprivation of capacity. Report writers could comment upon the presence or absence of Axis II conditions and the likely impact of any substances in the patient's system at the time of the offence.

Objective: Some literature suggests that compulsory community treatment orders (CTOs) are effective in reducing hospitalizations in a subgroup of psychiatric patients with histories of repeated hospitalization, allowing them to be treated in the community under less restrictive measures. However, studies have yielded contradictory findings, in part because of methodological differences. Our study examines the effectiveness of CTOs in reducing hospitalizations and increasing community tenure of such patients., Method: The sample included all psychiatric patients who had been given a CTO during a 9-year period at 2 of McGill University's hospitals. This is a naturalistic, observational, retrospective, before-and-after study where patients acted as their own control subjects. We examined variables, including the number, duration, and time to psychiatric admissions, comparing 4 time periods: early, pre-index, index (when the first CTO was in force), and post-index periods. The total study duration per subject encompasses the longest period of observation within existing studies in Canada., Results: Psychiatric patients with histories of frequent readmissions demonstrated a significant reduction in their number of hospitalizations as well as an increase in the median time to re-hospitalization, during the period when they were treated under a CTO. This effect of CTO was sustained even after the CTO had expired., Conclusions: Our study suggests that CTOs are effective in assisting psychiatric patients with histories of repeated hospitalizations to live and be treated in the community, diminishing the occurrence of frequent hospitalization.

Objective: The extent to which risk assessment advances have influenced release decision-making by review boards (RBs) of individuals found not criminally responsible on account of mental disorder (NCRMD) remains unclear. Our objective is to identify the psychosocial, criminological, and risk measure correlates of RB decision-making., Method: Data were collected through structured interviews and file reviews conducted between October 2004 and August 2006 in the sole forensic psychiatric hospital in Quebec and in 2 civil psychiatric hospitals in a large metropolitan area designated to care for people found NCRMD. The final sample consisted of 96 men., Results: Dynamic, clinical risk factors are associated with decisions to detain or release people found NCRMD, rather than traditional historical risk factors such as criminal history., Conclusion: Dynamic variables seem appropriate for the RBs to consider given the intention of the NCRMD legislation. Further, dynamic variables provide direction for titration of treatment and supervision. Results are discussed regarding enhancing evidence-informed RB dispositions.

In Portugal, offenders found not guilty by reason of insanity (NGRI), may be given a restricted order to a special hospital as an alternative to prison. In European countries there is a recognized need for data concerning this special population. The aim of the present study was to examine the characteristics of all the NGRI subjects (n = 274) detained in the country in a descriptive and retrospective survey conducted in January 2009. Offence committed, demographic factors, diagnosis at admission, background of substance abuse and diagnostic stability were recorded. Schizophrenia was the commonest diagnosis (51.5%). Mean population age was 42.6 years, with only 6.2% women. Homicide was the most common offense (41.2%). A background of substance abuse was found in 42.3% of subjects. There were significant differences in the schizophrenia and mental retardation patient groups when compared individually with the other diagnoses concerning homicide and arson as the offence. Mean duration of inpatient stay did not differ significantly between diagnoses. The findings also point to poor follow-up of the NGRI patients after admission.

Objective: The aim of the present study was to describe characteristics and post-release outcomes of Victorian homicide offenders under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (and/or its forerunner legislation) released from forensic inpatient psychiatric care since the development of specialist forensic services., Method: A legal database identified subjects meeting inclusion criteria: hospitalized in forensic psychiatric care due to finding of mental impairment or unfitness to stand trial for homicide in Victoria; released into the community; and released between 1 January 1991 and 30 April 2002. Using clinical records, demographics, index offence, progress in hospital, diagnosis, psychosocial and criminological data were obtained. Outcomes (offending or readmission into secure care) were obtained from the clinical records., Results: Of the 25 subjects, 19 (76%) were male. Primary diagnoses on admission to forensic hospital care were schizophrenia, n = 16 (64%); other psychotic disorder, n = 5 (20%); depression, n = 3 (12%); and personality disorder, n = 1 (4%). Mean time in custodial supervision was 11 years and 2 months, less for those whose offence occurred after the development of forensic rehabilitation services. In the first 3 years after release, there was a single episode of criminal recidivism, representing a recidivism rate of 1 in 25 (4%) over 3 years. Twelve subjects (48%) were readmitted at some point in the 3 year follow up., Conclusion: There was a very low rate of recidivism after discharge, but readmissions to hospital were common. Lengths of custodial care were reduced after the introduction of forensic rehabilitation facilities. Recidivism is low when there are well-designed and implemented forensic community treatment programmes, consistent with other data suggesting a reciprocal relationship between safe community care and a low threshold for readmission to hospital, lessening re-offending at times of crisis. Further research should be directed at timing of release decisions, based on reducing identified risk factors to acceptable levels.

Objective: The criminal justice system relies on the opinions of expert witness to assist in decisions about fitness to stand trial (FST) and verdicts of not guilty by reason of mental illness (NGMI). The aim of the present study was to assess the level of agreement between experts about these legal issues using a consecutive series of serious criminal matters in New South Wales., Methods: Pairs of reports from 110 consecutive criminal matters completed by the New South Wales Office of the Director of Public Prosecutions between 2005 and 2007 were examined. The opinions of experts about FST and NGMI were recorded., Results: Agreement about FST was fair-moderate (experts engaged by opposite sides, kappa = 0.293; experts engaged by the same side, kappa = 0.471), although there was a higher level of agreement in homicide matters. Agreement about NGMI was moderate-good (experts engaged by opposite sides, kappa = 0.508; experts engaged by the same side, kappa = 0.644) and there was a higher level of agreement when the experts also agreed about the diagnosis of schizophrenia. Further analysis using generalized estimating equations did not find a higher level of agreement about FST or NGMI in pairs of reports containing the opinion of experts from the same side., Conclusions: Little evidence was found for bias in expert opinions about either FST or NGMI, but the comparatively low level of agreement about FST suggests the need for reform in the way that FST is assessed.

Objective: Persons subject to forensic mental health orders imposed by the courts form a small but politically salient group. Their management provides a number of challenges for mental health services and for governments throughout Australia. Although their overall management has been enhanced by recent developments in forensic services, there is a lack of consistent cross-border agreements between states and territories. This paper will discuss how this situation is not conducive to effective risk management and is a denial of patients' legitimate demands for freedom of movement. A proposal for the adoption of appropriate principles to improve the current state of affairs is outlined., Conclusion: Legislative reform is required to ensure the safe and ethical management of mentally disordered offenders subject to forensic mental health orders in Australia.

We describe a new method, based on indirect measures of implicit autobiographical memory, that allows evaluation of which of two contrasting autobiographical events (e.g., crimes) is true for a given individual. Participants were requested to classify sentences describing possible autobiographical events by pressing one of two response keys. Responses were faster when sentences related to truly autobiographical events shared the same response key with other sentences reporting true events and slower when sentences related to truly autobiographical events shared the same response key with sentences reporting false events. This method has possible application in forensic settings and as a lie-detection technique.

Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors. Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences--not guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.

Objective: The aim of this paper is to describe the method of ethical analysis known as casuistry and consider its merits as a basis of ethical deliberation in psychiatry., Conclusions: Casuistry approximates the legal arguments of common law. It examines ethical dilemmas by adopting a taxonomic approach to 'paradigm' cases, using a technique akin to that of normative analogical reasoning. Casuistry offers a useful method in ethical reasoning through providing a practical means of evaluating the merits of a particular course of action in a particular clinical situation. As a method ethical moral reasoning in psychiatry, casuistry suffers from a paucity of paradigm cases and its failure to fully contextualize ethical dilemmas by relying on common morality theory as its basis.

Objective: This paper provides an overview of the insanity defence. An historical context is offered and each element of the M'Naghten Rules is discussed, highlighting differing interpretations within various jurisdictions. Discussion is offered on the role of expert evidence in addressing the 'ultimate issue' before the courts. Significant case law in relation to the insanity defence is highlighted., Conclusions: Psychiatrists have an important role to play in addressing issues central to the M'Naghten Rules and making these accessible and comprehensible to court and jurors in particular. Insanity is a legal construct designed to determine the extent to which a person may be deemed criminally responsible for a criminal act and is often difficult to reconcile within medical and public paradigms of mental illness and justice. Principles are offered to guide psychiatrists who are called to give evidence in cases where the mental illness defence has been raised.

Objective: This paper provides a conceptual, historical and legislative overview of fitness issues. These include fitness to be interrogated or charged, to plead, to be tried and to be sentenced in the context of Australia and New Zealand., Conclusions: Legislation regarding fitness issues needs to strike a balance between protecting the rights of mentally impaired defendants to a fair trial process and recognizing that mental illness in itself does not absolutely preclude participation in a trial process or necessarily diminish criminal responsibility. Although the key determinants of fitness seem to be the ability to cope with court processes and communicate with counsel, the application of clinical judgement to legal criteria is not always straightforward.

Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists.

Objective: To describe the characteristics of individuals found not criminally responsible on account of mental disorder (NCRMD) after the 1992 Criminal Code amendments and to track their movement through the forensic system, as well as to unveil the changes to British Columbia's forensic psychiatric system that resulted from Bill C-30., Method: Profile information relating to persons found NCRMD between February 4, 1992, and February 4, 1998, in British Columbia was collected and analyzed. Community follow-up data was collected and analyzed for a 24-month period following a subject's discharge from hospital., Results: A substantially greater number of individuals entered the forensic psychiatric system in British Columbia after Bill C-30 was implemented. The post-1992 forensic psychiatric population contained fewer persons charged with serious index offences and a greater number of persons charged with relatively minor offences. The length of hospitalization for the NCRMD cohort decreased substantially after the 1992 Criminal Code amendments., Conclusion: The Bill C-30 provisions have made the NCRMD defence an attractive option for defendants and legal counsel.

In a recent Scottish Appeal Court opinion (Kim Louise Scarsbrook or Galbraith v. Her Majesty's Advocate, 2001) it was successfully argued by the appellant that her conviction of murder was unsound inter-alia on the basis of overly restrictive pre-existing definitions of diminished responsibility in Scottish law resulting in unduly narrow directions being given by the trial judge to the jury in her case. We felt it timely to present a revised overview of the defence of diminished responsibility in Scotland and to consider the issues surrounding its applicability in cases of clinical depression. The psychiatric literature regarding depression and homicide is reviewed.

Objective: Our objective was to study the outcomes experienced by 2 communities after implementing pretrial diversion of offenders with mental illness., Method: The same method of diversion was implemented in a predominately urban and a predominantly rural county. We collected retrospective clinical and offence data from pretrial diversion assessments conducted in court. As well, we measured outcome for the diversion procedure in terms of actual vs expected rates of recidivism., Results: Prior psychiatric treatment was associated with the diverted group, and a criminal history was associated with the nondiverted group. In the larger, urban county the diversion option was offered more often to persons with psychoses, mood disorders, and minor offenses. Conversely, in the smaller rural county diversion was offered most often to persons accused of serious offenses. The recidivism found in urban and rural diverted groups after a year of supervised care was only 2% to 3%, but the rate of use of diversion in both counties was low, owing to selection biases., Conclusion: Pretrial diversion of offenders with mental illness accused of minor crimes is eminently feasible for both urban and rural settings, provided that police, crown, and treatment policies are coordinated to favour the treatment option rather than prosecution.

Objective: In Canada most evaluations of fitness to stand trial are conducted on an inpatient basis. This costs time and money, and deprives those defendants remanded for evaluation of liberty. This research assessed the predictive efficiency of the Fitness Interview Test, revised edition (FIT) as a screening instrument for fitness to stand trial., Method: We compared decisions about fitness to stand trial, based on the FIT, with the results of institution-based evaluations for 2 samples of men remanded for inpatient fitness assessments., Results: The FIT demonstrates excellent utility as a screening instrument. The FIT shows good sensitivity and negative predictive power, which suggests that it can reliably screen those individuals who are clearly fit to stand trial, before they are remanded to an inpatient facility for a fitness assessment., Conclusion: We discuss the implications for evaluating fitness to stand trial, particularly in terms of the need for community-based alternatives to traditional forensic assessments.

Objective: To discuss ethical and legal issues arising from research conducted on forensic psychiatric patients., Method: A review of the literature and ethical and legal guidelines related to research ethics with human subjects., Conclusion: Forensic patients who are research subjects are particularly vulnerable to coercion and abuse as a result of the dual vulnerabilities stemming from their status as both prisoners and psychiatric patients. Researchers in the area of forensic mental health must carefully consider ethical guidelines and ensure that the rights of participants are respected and upheld.

Objective: To systematically survey Alberta psychiatrists and lawyers regarding their knowledge of, attitudes toward, and experiences with the Criminal Code provisions regarding mentally disordered offenders to better understand the lack of impact in practice patterns., Method: A survey design was used, and 2 questionnaires, 1 for lawyers and 1 for psychiatrists, were developed and mailed out., Results: Out of 245 surveys sent to psychiatrists, 141 were returned, giving a response rate of 57%. The number of lawyers practising criminal law could not be determined, and 5273 surveys were sent to all lawyers on the Law Society of Alberta mailing list. Of these, 564 were returned, giving an overall response rate of 11%. The response rate for lawyers practising criminal law is unknown. Overall, lawyers were younger than psychiatrists. Most of the respondents in both groups were men. Overall, attitudes toward offenders with mental illness were very similar among lawyers and psychiatrists. Compared with lawyers, psychiatrists had significantly more correct responses to the items assessing knowledge. With a highest possible knowledge score of 27, the average score was 16 (SD 5.7) for psychiatrists and 13 (SD 7.23) for lawyers., Conclusions: The lack of familiarity with many of the key provisions among psychiatrists and lawyers is worrisome and suggests the need for educational materials to improve knowledge of the Criminal Code provisions governing mentally disordered offenders.

The purpose was to estimate the relationship between a defendant's stated intelligence on perceptions of his sanity and responsibility. This analog study was a 2 (occupation of defendant) x 2 (seriousness of outcome) between-subjects design. A scenario involving an insanity defense was read by 190 college students who then answered a 12-item questionnaire. The hypothesis that participants would attribute less responsibility to less intelligent defendants than to more intelligent ones was partially supported. Belief in a Just World moderated these evaluations. Seriousness of outcome influenced men's perceptions of the defendant's insanity, responsibility, and sentence, but not women's. Participants seemed to be more willing to accept the possibility that the defendant was insane if the outcome of his crime was not serious.

Objective: To determine whether fitness-to-stand-trial assessments "in detention" offer cost benefit over inpatient assessments., Method: The development of a pilot "fitness clinic" in a detention centre is described, and the results of 1 year of assessments are presented. The cost benefit of fitness assessments conducted in detention centres is outlined., Results: Significant cost savings were realized by operating fitness clinics in detention centres., Conclusion: Fitness clinics in detention centres offer important benefits and are recommended as an adjunct to forensic programs.

In this study, assessments of prisoners by doctors and nurses were compared in a provincial magistrates' court mental health assessment and diversion scheme, and outcomes were compared with the outcomes of those for whom no assessments were available during a control period. Substance misuse was relatively common and psychosis uncommon in the prisoners referred. Assessment by doctors enabled magistrates to reduce remands in custody of persons suspected of suffering from mental disorder and to grant bail in more cases. Only a small proportion of prisoners were admitted to hospital and although doctors and nurses recommended out-patient treatment in many cases, the attendance rate was low. Doctors were more likely than nurses to identify prisoners with medical needs that needed to be brought to the attention of the prison health care service, and to recommend out-patient psychiatric treatment and identify relevant medicolegal issues. Prisoners assessed by nurses were less likely than those assessed by doctors to attend alcohol or drug treatment services if recommended to do so. Prisoners who were admitted to hospital after a remand in custody spent longer on remand if assessed by nurses compared with those assessed by doctors.

The aim of this study was to investigate offenders' living patterns, quality of life, types of aftercare received and psychological well-being, following their diversion from one court diversion scheme in England. Sixty-five offenders were followed up after six months, 22 of whom were also followed up after one year. Their transient living patterns throughout these two periods were described. Their quality of life was found to be poor in that most did not have an occupation, nor did they receive education, and the life experiences during both periods were lower than that of standardized urban samples. There were no significant changes in their poor life experiences over the two periods. Over 55% of the 22 offenders still contacted their GPs regularly but there was a significant drop in those consulting hospital doctors. Only a small number of offenders had contact with the social services in these two periods and no significant differences were found between them. Their GHQ total scores went above cutoff point and the level of psychiatric conditions was similar in both periods.

This study examined an important question relevant to the domain of the insanity defense: What are the interrelationships among important evidential and attitudinal factors which influence how jurors decide their final verdicts? To answer this question, a mock trial in which the insanity defense was argued was presented to 224 college undergraduates by means of an audiotape and slide show. Following the presentation, participants were asked to answer a series of questions regarding the trial. A path model was specified with four evidential factors as endogenous variables, i.e., evaluation of the defendant's mental status, belief that the defendant could be rehabilitated, beliefs regarding the accuracy of the expert witnesses, and mock-jurors' predeliberation verdicts. In addition, three attitudinal factors were specified as exogenous variables, i.e., attitudes toward the insanity defense, attitudes towards due process vs crime control, and attitudes towards the death penalty. The path model was consistent with previous literature, suggesting that jurors' attitudes toward the death penalty and the insanity defense had a direct effect on how they evaluated the accuracy of the expert testimony and their evaluation of the defendant's over-all mental status. In turn, mock jurors' evaluations of the defendant's mental status had a direct effect on their selections of verdict. Importantly, mock jurors' evaluations of the evidential factors, particularly the mental status of the defendant, were a stronger predictor of their selections of verdict than were their initial attitudes.

Objective: This paper is written with the aim of presenting a series of cases of folie à deux, an unusual disorder, occurring in a forensic setting where all the victims suffered a fatal or near-fatal outcome. Similarities in the psychopathology in these cases are drawn and comments are made about their outcome in court. The paper is also written to draw attention to the potential risks involved in this type of case and to accent patterns in psychopathology and in legal outcomes., Clinical Picture: Five folie à deux cases are described. All are well known to one of the authors (NK), who has treated them at some stage of their illness, provided medicolegal reports for the trial of cases 3, 4 and 5, and provided expert witness testimony in the trial of case 3. All case notes and other relevant documents were studied in detail and a brief summary is provided for each case., Outcome: The cases appear to conform with the description of folie à deux given in the literature and consist of husband and wife (three cases), mother and daughter (one case) and twin brothers (one case). None of these cases had had any past psychiatric or criminal history, yet all the victims suffered a fatal or near fatal outcome. Additionally, all had shared religious delusions in one form or another., Conclusions: Folie à deux cases with shared religious delusions can be a very high risk and could be potentially fatal in a family setting. The authors also highlight the difficulties inherent in a forensic system restricted to McNaughton rules, particularly when a person is on trial having committed, or being alleged to have committed, a serious offence, and who is found to be suffering from a psychotic illness.